Clinical Aspects of Arthritis
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What are types of arthritis?
What is an important test to do for septic arthritis?
Joint aspiration + blood cultures - to find microorganisms
Why is it important not to miss septic arthritis?
Sepsis can spread -> death Bone and joints can be completely eroded or destroyed (will require joint replacement)
What is gout?
Excess of uric acid crystals that precipitate in the joint, on a spectrum.
Is raised serum urate level diagnostic of gout?
Hyperuricaemia can lead to acute gout, which can cause chronic tophaceous gout.
What is the first line of treatment for acute gout?
Aim is to reduce inflammatory response to crystals: • NSAIDs • Colchicine • (steroids)
After an acute attack of gout, following first line of treatment you need to lower the serum uric acid level. What drugs reduce serum uric acid level?
• Xanthine oxidase inhibitors (allopurinol, febuxostat) • Uricosuric drugs (benzbromarone) • Synthetic uricase (pegloticase)
What are the lifestyle risk factors for gout?
• Diuretics • Weight (bmi, triglyc, bp) • Red meat, shellfish • Alcohol • Sugary/fructose drinks
What lifestyle factors can help to treat gout?
• Cherries • Vitamin C • Coffee
Does everyone with hyperuricaemia get gout?
No - hyperuricaemia can be associated with genetics (50%) but no history of gout. Improve lifestyle first over drug treatment.
What is the target conc for serum uric acid?
< 360 micromols/L
What class/type of arthritis is rheumatoid arthritis?
Inflammatory -> poly-symmetrical -> RA
What are the aims of RA drug treatment?
• Switch off joint inflammation early • Prevent bone erosions and joint deformity • Prevent disability
What is RA drug treatment?
Disease modifying drugs (DMARDs) • Start EARLY - within 3 months • Oral - methotrexate, sulfasalazine • Injections - biologics eg. antiTNF drugs Symptomatic treatment - NSAID, steroids, analgesia Lifestyle treatment - reduce risk factors eg. smoking
What is the difference between inflammatory and non-inflammatory arthritis symptoms?
Inflammatory: • Pain worse with rest • Early morning stiffness > 30 mins • Systemic symptoms • Tenderness • Soft swelling + hot/red joint Non-inflammatory: • Pain worse w/ exercise • Minimal EMS • No systemic symptoms • Tenderness • Hard (bony) swelling
Which joints do rheumatoid and osteoarthritis most commonly affect?
• RA - MCP/PIP/wrist joints • OA - DIP/1st CMC joint
What is the aetiology of osteoarthritis?
• Genetic - eg. nodal OA affecting DIPJs • Age • Trauma • Obesity • Malalignment • Other
What is the treatment of osteoarthritis?
• Aim = reduce symptoms • No disease modifying treatment available yet (unlike for RA) • Analgesia/NSAIDs • Lifestyle - weight loss, exercise • Surgery - joint replacement (arthroplasty)
What gene gives causes ankylosing spondylitis?
HLA B27